References

Selected References

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.

Chopra A, Doiphode VV. Ayurvedic medicine-core concept, therapeutic principles, and current relevance. Medical Clinics of North America. 2002;86(1):75–88.

Courson WA. State licensure and Ayurvedic practice: planning for the future, managing the present. Newsletter of the National Ayurvedic Medical Association [online journal]. Autumn 2003. Accessed on February 14, 2008.

Dodds JA. Know your CAM provider. Bulletin of the American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons [online journal]. December 2002. Accessed on February 14, 2008.

Gogtay NJ, Bhatt HA, Dalvi SS, et al. The use and safety of non-allopathic Indian medicines. Drug Safety. 2002;25(14):1005–1019.

Lead poisoning associated with Ayurvedic medications—five states, 2000–2003. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention Web site. Accessed on February 14, 2008.

Lodha R, Bagga A. Traditional Indian systems of medicine. Annals of the Academy of Medicine, Singapore. 2000;29(1):37–41.

Mishra L, Singh BB, Dagenais S. Ayurveda: A historical perspective and principles of the traditional healthcare system in India. Alternative Therapies in Health and Medicine. 2001;7(2):36–42.

Mishra L, Singh BB, Dagenais S. Healthcare and disease management in Ayurveda. Alternative Therapies in Health and Medicine. 2001;7(2):44–50.

Saper RB, Kales SN, Paquin J, et al. Heavy metal content of Ayurvedic herbal medicine products. Journal of the American Medical Association. 2004;292(23):2868–2873.

Shankar K, Liao LP. Traditional systems of medicine. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):725–747.

Singh BB, Vinjamury SP, Der-Martirosian C, et al. Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs. Alternative Therapies in Health and Medicine. 2007;13(4):22–28.

Subbarayappa BV. The roots of ancient medicine: an historical outline. Journal of Bioscience. 2001;26(2):135–144.

Treatment

Ayurvedic treatment is tailored to each person's constitution. Practitioners expect patients to be active participants because many Ayurvedic treatments require changes in diet, lifestyle, and habits.
The patient's dosha balance. Ayurvedic practitioners first determine the patient's primary dosha and the balance among the three doshas by:

• Asking about diet, behavior, lifestyle practices, recent illnesses (including reasons and symptoms), and resilience (ability to recover quickly from illness or setbacks).
• Observing such physical characteristics as teeth and tongue, skin, eyes, weight, and overall appearance
• Checking the patient's urine, stool, speech and voice, and pulse (each dosha is thought to make a particular kind of pulse).

Treatment practices. Ayurvedic treatment goals include eliminating impurities, reducing symptoms, increasing resistance to disease, and reducing worry and increasing harmony in the patient's life. The practitioner uses a variety of methods to achieve these goals:

• Eliminating impurities. A process called panchakarma is intended to cleanse the body by eliminating ama. Ama is described as an undigested food that sticks to tissues, interferes with normal functioning of the body, and leads to disease. Panchakarma focuses on eliminating ama through the digestive tract and the respiratory system. Enemas, massage, medical oils administered in a nasal spray, and other methods may be used.
• Reducing symptoms. The practitioner may suggest various options, including physical exercises, stretching, breathing exercises, meditation, massage, lying in the sun, and changing the diet. The patient may take certain herbs—often with honey, to make them easier to digest. Sometimes diets are restricted to certain foods. Very small amounts of metal and mineral preparations, such as gold or iron, also may be given.
• Increasing resistance to disease. The practitioner may combine several herbs, proteins, minerals, and vitamins in tonics to improve digestion and increase appetite and immunity. These tonics are based on formulas from ancient texts.
• Reducing worry and increasing harmony. Ayurvedic medicine emphasizes mental nurturing and spiritual healing. Practitioners may recommend avoiding situations that cause worry and using techniques that promote release of negative emotions.

Use of plants. Ayurvedic treatments rely heavily on herbs and other plants—including oils and common spices. Currently, more than 600 herbal formulas and 250 single plant drugs are included in the "pharmacy" of Ayurvedic treatments. Historically, Ayurvedic medicine has grouped plant compounds into categories according to their effects (for example, healing, promoting vitality, or relieving pain). The compounds are described in texts issued by national medical agencies in India. Sometimes, botanicals are mixed with metals or other naturally occurring substances to make formulas prepared according to specific Ayurvedic text procedures; such preparations involve several herbs and herbal extracts and precise heat treatment.

Ayurveda: The holistic way of life

Ayurveda is not only a medicine system, it is a holistic way of life that takes care of all aspects of human well-being—physical, mental and spiritual. Adopting the ayurvedic way of life is a valuable first step towards becoming a truly integrated individual
In Western medicine and biology, scientists are good at analyzing reality minutely. The amazing progress in medical sciences and technology has provided us with fantastic diagnostic methods and helped us understand cellular functions at diverse levels. However, it does not mean that this progress has found solutions for many of the human problems related to body and mind.
In fact, this knowledge has enhanced health problems as profit-making agencies have stuffed human beings the world over with chemical drugs, with their inevitable harmful side effects. Besides, modern medical sciences have dissociated the human body from the mind. Human beings are treated like machines and various 'mechanisms' of the body are understood at physiological and molecular levels and malfunctions are treated by physical and/or chemical interventions.
Modern medicine and science are uncomfortable with 'consciousness' or 'soul' and spiritual healing is seen as superstition or magic. All experiences that are beyond the limits of the senses are denied. Chance plays an important role in phenomena causing disease, and both time and matter are reduced to smaller units.
Ayurveda, however, is based on the theory that reality is multi-dimensional and multi-layered. Diverse aspects of existence are interrelated, interconnected and interdependent. Nothing is without reason, or happening by chance, and all is moving towards a definite goal. Matter is dynamic and constantly changing. It is this transformation that denotes time.
The World of Science encyclopedia says: "Consciousness is a problem. We all think we know what it is. Each of us likes to think that I am some kind of conscious entity inhabiting 'my' body, making decisions and acting freely. This naïve view may be no more accurate than the naïve view of perception-a self inside the head looks directly out of the eyes at a world outside. Nevertheless, while psychology, physiology and research in artificial intelligence have revealed a clearer picture of the constructive nature of perception, they have not yet found appropriate ways of tackling consciousness."Yoga and ayurveda are, however, clear about the self, consciousness and the mental and physical dimensions of a human being.

THE THREE VITAL FORCESMost of you would be familiar with vata, pitta and kapha, the three dimensions (doshas) of the physical realm. All that exists, including the human body, is made of five elements—ether, air, fire, water and earth. In a living being, the elements are organised in the form of three doshas-vata (from ether and air), pitta (from fire) and kapha (from water and earth)-to perform the physical and mental functions. The three doshas or humors need to be in equilibrium for the body to be in good health. When one or more of them are vitiated, disorders or ailments arise.
Presence of the three vital forces in varied proportions gives you your fundamental constitution or prakriti. Prakriti does not only denote your physical characteristics but also your personality type, like extremely active and agile (vata-dominant), dynamic and short-tempered (pitta-dominant), content and home loving (kapha-dominant).

THREE QUALITIES OF THE MIND There are three qualities of the mind that are interconnected, interrelated and interdependent with the three vital forces of the body. These are sattva, rajas and tamas. Sattva includes equilibrium, goodness, truth, compassion, stillness and peace. Rajas includes thinking, planning and taking decisions. Tamas is that which hinders motion (like sleep) or the expansion of the mind (greed, anger, jealousy, laziness). After a hectic day of work, the body and mind come to rest and sleep. That is transformation from rajas to tamas, as in the latter, all activities are hindered and senses withdraw partially from the external world. The mind is closed to new knowledge.
Sattva brings peace and balances action and non-action. The imbalance of sattva, rajas and tamas influences the equilibrium of the doshas—and vice versa—and may also cause mental ailments. For good health and longevity, a six-dimensional equilibrium is essential.

THE SIX-DIMENSIONAL BEING Our state of mind influences our principal energies, which are responsible for physical and mental functions of the body. For example, if we are stressed, vata gets vitiated. Anger causes pitta-related disorders like stomach ailments. Depression gives rise to kapha-related disorders, leading to obesity, nausea, excessive salivation and so on.
When a humor vitiates, causing related disorders, the mental state of an individual is also influenced. For instance, if constipation persists, it can give rise to sleep disorders, overactive mental state or nervous behavior. Stomach problems, which are due to pitta disturbances, may enhance anger and irritation.
For maintaining good health and well-being, efforts at all the six dimensions are called for. Charaka lays great emphasis on santosh (contentment) and sattva for maintaining good health. In practice, sattva is to maintain stillness and peace of mind in all circumstances. Sattva is that inner light that guides us through life, gives us peaceful and restful sleep and helps maintain equilibrium of the body and mind.

THE SIX-DIMENSIONAL EQUILIBRIUM OF DOSHAS AND GUNAS
SOUL-THE CAUSE OF BEING
The three qualities of mind and their equilibrium depict the second level of our being. Now, there is a higher level of energy that is the cause of being—the Self, or soul. Soul is not involved in our karma, but is our continuity in this universe. It radiates life in every cell and makes us conscious beings.
Soul is the energy that makes the senses and the mind work making existence possible. However, existence is not possible without material reality. This essentially springs from Sankhya, one of the six schools of ancient Indian philosophy. The second chapter of the Bhagavad Gita is devoted to expounding Sankhya and several other chapters also refer to it. According to Sankhya, the phenomenal world arises when purusha, the Universal Soul combines with prakriti, the Cosmic Substance. The Charaka Samhita contains a detailed analysis of the 24 elements of human existence based on Sankhya.MIND, PSYCHE AND INTELLECTIn ayurveda, the mind is considered to be the sixth sense that reins in the other five senses. Sattva is the stillness of mind, or mind in its pure form. When the mind is silent and not involved with the senses, it is one with the cause of being, the soul. That is the state when the intellect is awakened completely and has a power of discretion.
Mind is the 'capability of thinking'. Its nature or vritti is to have a chain of thoughts. In Sanskrit, the word chitta is used for the thinking principle of the mind (Patanjali's Yoga Sutras, I:2). The power of the mind to control itself as well as the senses is called psyche or mati (influenced by the energy of the soul) is buddhi or intellect.

SATTVA: KEY TO HEALTH AND HAPPINESS Charaka said that discontentment or asantosh is the cause of ailments. It leads to greed, envy, jealousy, competition, anger and confusion. All these enhance rajas and tamas. Contentment is a state of mind rather than something that is attained with worldly possessions.
Our daily lives are predominantly rajas and tamas. They can be balanced by bringing sattva in every activity and the sattvic state of mind should be used to take major decisions. One should make every effort to get rid of factors that enhance rajas and tamas and try to inculcate sattva-enhancing values. In order to strengthen sattva, you have to get rid of fear, grief, greed and confusion. Fear and greed lead to other negative qualities such as jealousy, excessive attachment, possessiveness and dissatisfaction. All these qualities decelerate your work efficiency.
Charaka wrote: "Sattva-dominant persons are endowed with memory and devotion, they are grateful, learned, pure, courageous, skilful, resolute, fighting in battle with prowess, free from anxiety, having well-directed, serious intellects and activities and do virtuous acts."
With a sattva state of mind, you can know both your body and mind better. Sattva enables you to silence your mind, which in turn enables you to listen to your inner being. We learn to withdraw the senses at will and may also develop extra-sensory perception (ESP). ESP can help us diagnose ourselves and enable us to choose a correct medical treatment and do spiritual healing. Charaka talks about sattvavajya, a therapy defined as protecting the mind from unwholesome objects.
To enhance sattva, one needs to control one's mind, which can be done through yogasanas, pranayama and japa. Equally essential is to have all the humors in equilibrium. That is why, in yoga, great emphasis is laid on purifying the body.
Vata controls the activities of the mind. If vata is imbalanced, it would be hard to control the mind. A massage and a warm bath, appropriate rest and nutrition help calm down the mind and enhance its capacity to develop self-control. A multidimensional approach has to be applied to enhance sattva.

AYURVEDA AND PSYCHOLOGY Modern psychology is defined as the 'science of mind and behavior'. In this fragmented approach, reality is perceived only at the sensory level. People's behavior and thoughts are given rational explanations and there is a lack of individual responsibility. In ayurveda, an individual's behavior is completely his or her responsibility. The basic behavior and reactions are seen as the result of prakriti, which is seen as stemming from your samskaras. At other levels, behavior is categorized as familial, social and so on, influenced by past and present karma, which are also due to individual responsibility. Nature has provided intellect to distinguish between good and bad karma. Freedom lies in present karma. With sattva actions, one can even influence the results of past karma.
To linger on with the dark past is tamas and for a healthier mind and body, one should evoke the light of sattva to get rid of the darkness of tamas.
Ayurvedic psychology is an expansive field and can help people to get rid of their mental pains and ailments even in modern times.

AYURVEDA TODAYReacting to the inadequacy of the fragmented approach of modern medicine, many alternatives have emerged. In the 1980s when I founded my organization and started doing research and writing work, ayurveda was little known in the West. The fact that it has spread the world over in such a short time speaks for the yearning people have for a holistic approach where they are considered as complete individuals with all dimensions of existence.
The fulfillment of our aspirations lies in a holistic approach. The dynamic cosmos has us, the human being, as its pulse. Once we begin seeing that, we will take better care of ourselves and our environment. Says the Bhagavad Gita (XVIII, 22): "That knowledge which clings to each individual thing as if it were the whole is irrational, without any real objective and is narrow and tamasic."For each of us, the aim should be to see our complete being in different dimensions and at different levels and to look at ourselves as the energetic and creative beings throbbing in this dynamic universe. The principle aim of life should be to live in tune with the cosmic rhythm, which is only possible with holistic wisdom.

Safety Concerns

Safety Concerns

There is evidence that using some Ayurveda medicine, especially those involving herbs, metals, minerals, or other materials involves potentially serious risks, including toxicity.
A study by Saper etc. published in 2004 in the Journal of the American Medical Association studied the chemistry of Ayurveda compounds and found significant levels of toxic heavy metals such as lead, mercury and arsenic in 20% of Ayurvedic preparations that were made in South Asia for sale around Boston and extrapolated the data to America.[66] The Journal found that, if taken according to the manufacturers' instructions, this 20% of remedies "could result in heavy metal intakes above published regulatory standards" Similar studies have been performed in India, and have confirmed the presence of heavy metals. The main concern of metal toxicity from misuse of Ayurvedic medicines are well known.
There is a technique of detoxification applied to heavy metals and toxic herbs called samskaras, which is similar to the Chinese pao zhi although the Ayurvedic technique is more complex and may involve prayers as well as physical pharmacy techniques.
Following the study conducted by Saper etc. the Government of India ruled that Ayurvedic products must specify their metallic content directly on the labels of the product. The harmful effects of Ayurveda are attributed in part to the adulterated raw material and lack of workers trained in traditional medicine. In a letter to the Indian Academy of Sciences, Patwardhan Bhushan—director of the Interdisciplinary School of Health Sciences, University of Pune—cites Saper etc. and states that contamination and carelessness during the modern manufacturing processes, quicker than the safer traditional methods of preparation, is to blame for the heavy level of toxicity in traditional medicine. The flawed output has resulted in decline of Ayurveda in India as well as abroad.

Scientific Evidence

Scientific evidence

As a traditional medicine, many Ayurveda products have not been tested in rigorous scientific studies and clinical trials. The National Center for Complementary and Alternative Medicine states that "most clinical trials of Ayurvedic approaches have been small, had problems with research designs, lacked appropriate control groups, or had other issues that affected how meaningful the results were." In India, research in Ayurveda is largely undertaken by the statutory body of the Central Government, the Central Council for Research in Ayurveda and Siddha (CCRAS), through a national network of research institutes. However, an excerpt from Nanda (2006) reads: "clinical studies that would satisfy the liberal criteria of WHO [World Health Organisation] have been alarmingly few from India, in spite of patients crowding in Ayurvedic hospitals."
Despite these misgivings, some ayurvedic products, mainly herbs used for phytotherapy, have been tested with promising results. Turmeric and its derivative curcumin appears to have beneficial properties. Tinspora cordifolia has been tested. Among the medhya rasayanas (intellect rejuvenation), two varieties of sage have been been tested; one improved word recall in young adults, and another improved symptoms in Alzheimer's patients. In some cases Ayurvedic medicine may provide clues to therapeutic compounds. For example, derivatives of snake venom have various therapeutic properties. Many plants used as rasayana (rejuvenation) medications are potent antioxidants. Neem appears to have beneficial pharmacological properties as well.
A systematic review of Ayurveda treatments for rheumatoid arthritis concluded that there was insufficient evidence, as most of the trials were not done properly, and the one high-quality trial showed no benefits. A review of Ayurveda and cardiovascular disease concluded that while the herbal evidence is not yet convincing, the spices are appropriate, some herbs are promising, and yoga is also a promising complementary treatment.
Mitra & Rangesh (2003) hold that cardamom and cinnamon are believed to stimulate digestive enzymes that break down polymeric macromolecules in the Human body. Research suggests that Terminalia arjuna is useful in alleviating the pain of angina pectoris and in treating heart failure and coronary artery disease. Terminalia arjun may also be useful in treating hypercholesterolemia. Azadirachta indica is believed to have immunopotentiating abilities and is used often as an anti-infective. It has been found to enhance the production of IL-2 and increase immunity in human volunteers by boosting lymphocyte and T-cell count in three weeks. Both black pepper and long pepper find application in Ayurvedic medicine in conjunction with ginger to form trikatu—a the traditional mixture. Trikatu has been suggested to increase appetite, promote the secretion of digestive juices, and cure certain gastric disorders—particularly Achlorhydria and Hypochlorhydria.

Current Status

Within South Asia

In 1970, the Indian Medical Central Council Act was passed by the Parliament of India, which aims to standardize qualifications for Ayurveda and provide accredited institutions for its study and research. In India, over 100 colleges offer degrees in traditional Ayurvedic medicine. Indian Government supports research and teaching in Ayurveda through many channels—both at the national and state levels—and helps institutionalize traditional medicine so that it can be studied in major towns and cities. The state-sponsored Central Council for Research in Ayurveda and Siddha (CCRAS) is the apex institution for promotion of traditional medicine in India. The studies conducted by this institution encompass clinical, drug, literary, and family welfare research.
Many successful clinics are run by professionals who qualify from these institutes—both in the urban and the rural areas. Mukherjee & Wahile cite World Health Organization statistics to demonstrate the popularity of traditional medicine, on which a significant number of the world's population depends for primary health care. In Sri Lanka the number of traditional Ayurveda practitioners is greater than trained modern medicine professionals. The manufacture and marketing of Ayurvedic medicine has been commercially successful for several pharmaceutical companies.

Outside India

Ayurveda practitioners require a license in another stream of health care in the United States of America. Academic institutions related to traditional medicine in India have contributed to Ayurveda's international visibility. Kurup (2003) comments on the role of Gujarat Ayurved University: The Gujarat Ayurved University has signed the Memorandum of Understanding (MoU) with nine Ayurvedic institutes functioning in Japan, Australia, the Netherlands, Italy, Argentina, and Germany to coordinate and facilitate the globalization of Ayurveda through academic collaboration. Earlier, Medical (Ayu) Institute of Russia had signed the MoU with the Government of India, in which Gujarat Aryurved University is also one of the implementing authorities.
Ayurveda gained recognition in the Western world as medical scholars researched and outlined its various postulates. In the United States of America, the NIH NCCAM expends some of its $123 million budget on Ayurvedic medicine research. In addition, the National Institute of Ayurvedic Medicine, established by Dr. Scott Gerson, is an example of a research institute that has carried out research into Ayurvedic practices. Gerson has published part of his work on the antifungal activities of certain Ayurvedic plants in academic journals. The postulates and history of Ayurveda have also been outlined by foreign scholars—such as Dominik Wujastyk in the United Kingdom.

Patents

In December 1993, the University of Mississippi Medical Center had a patent issued to them by United States Patent and Trademark Office on the use of turmeric for healing. The patent was contested by India's industrial research organization, Council for Scientific and Industrial Research (C.S.I.R), on the grounds that traditional Ayurvedic practitioners were already aware of the healing properties of the substance and have been for centuries, making this patent a case of bio-piracy. The Government of India had become involved in promoting traditional medicine by 1997. Sharma & Bodeker report on the various government activities in relation with Ayurveda: In India the government became involved in traditional drug production when the Central Drug Research Institute patented two new drugs from ancient Ayurvedic formulas. One, a mixture of black pepper, long pepper, and ginger, allows for the dosage of the antibiotic rifampicin to be halved in the treatment of tuberculosis and other mycobacterial infections. The other is a memory tonic produced from the traditional plant called brahmi. Overseas patenting of turmeric and products of the neem tree caused controversy in India and other nations. In August the U.S. Patent and Trademark Office canceled a U.S. patent on the wound-healing properties of turmeric when the Indian government proved that records had existed for this use for centuries.

Practices

Practices

Buddhism may have been an influence on the development of many of Ayurveda's central ideas—particularly its fascination with balance, known in Buddhism as Madhyamika (Devanāgarī: मद्यमिका). Balance is emphasized and suppressing natural urges is seen to be unhealthy and doing so may almost certainly lead to illness. To stay within the limits of reasonable balance and measure is stressed upon. Ayurveda emphasizes on moderation in food intake, sleep, sexual intercourse, and the intake of medicine.
Ayurveda incorporates an entire system of dietary recommendations.Chopra (2003)—on the subject of Ayurveda dietetics—writes:
Ayurvedic dietetics comprise a host of recommendations, ranging from preparation and consumption of food, to healthy routines for day and night, sexual life, and rules for ethical conduct. In contrast to contemporary practitioners of New Age Ayurveda, older Ayurvedic authors tended to be religiously neutral. Even Buddhist authors refrained from trying to convert the patient to follow their particular religious ways.
For diagnosis the patient is to be questioned and all five senses are to be employed. The Charaka Samhita recommends a tenfold examination of the patient. The qualities to be judged are: constitution, abnormality, essence, stability, body measurements, diet suitability, psychic strength, digestive capacity, physical fitness and age. Hearing is used to observe the condition of breathing and speech. The study of the vital pressure points of marma is of special importance.
Chopra (2003) identifies five influential criteria for diagnosis: 'origin of the disease, prodrominal (precursory) symptoms, typical symptoms of the fully developed disease, observing the effect of therapeutic procedures, and the pathological process.
Hygiene—also a component of religious virtue to many Indians—is a strong belief. Hygienic living involves regular bathing, cleansing of teeth, skin care, and eye washing. Occasional anointing of the body with oil is also prescribed.
Ayurveda stresses on vegetable drugs. Fats are used both for consumption and for external use. Hundreds of vegetable drugs are employed, including cardamom and cinnamon. Some animal products may also be used, for example milk, bones, and gallstones etc. Minerals—including sulfur, arsenic, lead, copper sulfate, gold—are also consumed as prescribed.
Alcohol is used as a narcotic for the patient undergoing operation in some cases. The advent of Islam introduced opium as a narcotic. Both oil and tar are used to stop bleeding. Oils may be used in a number of ways including regular consumption as a part of food, anointing, smearing, head massage, and prescribed application to infected areas.
The proper function of channels—tubes that exist within the body and transport fluids from one point to another—is seen as vital, and the lack of healthy channels may lead to disease and insanity. Sushruta identifies that blockages of these channels may lead to rheumatism, epilepsy, paralysis, and convulsions as fluids and channels are diverted from their ideal locations. Sweating is favored as a manner in which to open up the channels and dilute the Doshas causing the blockages and harming a patient—a number of ways to take steam bathing and other steam related cures are recommended so that these toxins are released.